ABSTRACT
In Japan, there are no predetermined guidelines on the management of pregnant women at 41 weeks of pregnancy. In our hospital, pregnant women at 41 weeks of pregnancy are candidates for induction, but induction may result in emergency caesarean section, atonic bleeding postpartum hemorrhage, and neonatal emergencies with admission to the Neonatal Intensive Care Unit (NICU). Therefore, we conducted a retrospective investigation to determine which cases are likely to end in such events. Our hospital recorded a total of 3,492 deliveries during the period 2013-2015. Of these, 382 pregnancies were delivered at 41 weeks. We compared the labor induction group and the spontaneous delivery group. The rate of emergency caesarean section for multiparas was 1％ and was as high as 21％ for primiparas, so we focused on primiparas in this study. The 258 primiparas from among all 382 cases were divided into the induction group (n＝122) and the spontaneous group (n＝136). Compared with the spontaneous group, the induction group had older primiparas, more body weight gain during pregnancy, and a high risk of emergency caesarean section. There was no significant difference in the proportion of neonates admitted to the NICU. In the analysis focused on the induction group, the rate of emergency cesarean section increased as the number of cases requiring induction and the number of elderly primiparas increased. With the recent increasing age of primiparas, it is necessary to educate women on the risks of weight gain during pregnancy.
ABSTRACT
Trousseau's syndrome is a condition in which thromboembolic events are triggered by hypercoagulation caused by a malignancy. Here, we report two cases in which gynecologic cancer was detected after cerebral infarction. Patient 1 was a 66-year-old gravida 0, para 0 who presented with left-sided arm and leg weakness. Head magnetic resonance imaging (MRI) facilitated a diagnosis of cerebral infarction. Subsequent contrast computed tomography (CT) revealed an ovarian tumor, and she underwent surgery on day 8 after admission. The tumor was diagnosed as ovarian clear cell carcinoma on pathological examination. She received adjuvant chemotherapy and the cancer has not progressed in more than 2 years after the surgery. Patient 2 was a 41-year-old gravida 1, para 1 who presented with impairment of consciousness, right hemiplegia, and aphasia. Head MRI facilitated a diagnosis of cerebral infarction. Contrast MRI and contrast CT findings were suggestive of endometrial cancer, and she underwent surgery on day 19 after admission. The cancer was diagnosed as grade 3 endometrial cancer on pathological analysis. She received adjuvant chemotherapy and the cancer has not progressed in more than 4 years after the surgery. Although treatment of the primary disease is considered to affect prognosis in Trousseau’s syndrome, many patients have poor survival prospects because, when detected, their cancer is too advanced to be treated surgically. These cases illustrate the need for close cooperation with other departments such as neurology and cerebrovascular surgery to ensure that these cancers are diagnosed quickly and the opportunity to start multimodality treatment is not missed.
